<!--_meta 作为公共模版分离出去-->
<!DOCTYPE HTML>
<html>
<head>
<meta charset="utf-8">
<meta name="renderer" content="webkit|ie-comp|ie-stand">
<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1">
<meta name="viewport" content="width=device-width,initial-scale=1,minimum-scale=1.0,maximum-scale=1.0,user-scalable=no" />
<meta http-equiv="Cache-Control" content="no-siteapp" />
<link rel="Bookmark" href="/favicon.ico" >
<link rel="Shortcut Icon" href="/favicon.ico" />
<!--[if lt IE 9]>
<script type="text/javascript" src="lib/html5shiv.js"></script>
<script type="text/javascript" src="lib/respond.min.js"></script>
<![endif]-->
<link rel="stylesheet" type="text/css" href="static/h-ui/css/H-ui.min.css" />
<link rel="stylesheet" type="text/css" href="static/h-ui.admin/css/H-ui.admin.css" />
<link rel="stylesheet" type="text/css" href="lib/Hui-iconfont/1.0.8/iconfont.css" />
<link rel="stylesheet" type="text/css" href="static/h-ui.admin/skin/default/skin.css" id="skin" />
<link rel="stylesheet" type="text/css" href="static/h-ui.admin/css/style.css" />
 
<style type="text/css">
        *{
            margin: 0;
            padding: 0;
        }
        a{
            text-decoration: none;
        }
        ul, li{
            list-style: none;
        }
        #print-content{
            width: 98%;
            margin: 10px auto;
        }
        .tableTopBorder_3{
            border-collapse: collapse;
            border: 1px solid #000;
            border-top: 0px solid #000;
        }
        .tableTopBorder_3 td, .tableTopBorder_3 th{
            border: 1px solid #000;
            text-align: center;
            padding: 3px 5px;
        }
        @media print{
            .pageBreak{
                page-break-after: always; /*强制换页的关键*/
            }
            .noPrint{
                display: none;
            }
        }
    </style>
<!--[if IE 6]>
<script type="text/javascript" src="lib/DD_belatedPNG_0.0.8a-min.js" ></script>
<script>DD_belatedPNG.fix('*');</script>
<![endif]-->
<!--/meta 作为公共模版分离出去-->
</head>
<body>
    <div id="print-content">
        <h3 style="text-align: center;">基本登记信息</h3>
        <table class="tableTopBorder_2">
           <tbody>
                   <tr>
                       <td>
                           <span>姓名：</span>
                           <span>张三</span>
                       </td>
                       <td>
                           <span>性别：</span>
                           <span>男</span>
                       </td>
                       <td>
                           <span>国籍：</span>
                           <span>中国</span>
                       </td>
                       <td>
                           <span>名族：</span>
                           <span>维吾尔族</span>
                       </td>
                   </tr>
                   <tr>
                       <td>
                           <span>生日：</span>
                           <span>2019-08-08</span>
                       </td>
                       <td>
                           <span>社保类型：</span>
                           <span>城镇灵活就业社会保险</span>
                       </td>
                       <td>
                           <span>血型：</span>
                           <span>AB型</span>
                       </td>
                       <td>
                           <span>生活方式：</span>
                           <span>与老伴同居</span>
                       </td>
                   </tr>
                   <tr>
                       <td>
                           <span>婚姻状况：</span>
                           <span>未婚</span>
                       </td>
                       <td>
                           <span>老人爱好：</span>
                           <span>吃饭睡觉打豆豆</span>
                       </td>
                       <td>
                           <span>紧急号码和老人关系：</span>
                           <span>父子</span>
                       </td>
                       <td>
                           <span>紧急联系人：</span>
                           <span>李四</span>
                       </td>
                   </tr>
                   <tr>
                       <td>
                           <span>出生日期：</span>
                           <span>2019-01-02</span>
                       </td>
                       <td>
                           <span>学历：</span>
                           <span>研究生以上学历</span>
                       </td>
                       <td>
                           <span>籍贯：</span>
                           <span>北京市</span>
                       </td>
                       <td>
                           <span>紧急号码：</span>
                           <span>16666666666</span>
                       </td>
                   </tr>
                   <tr>
                       <td>
                           <span>政治面貌：</span>
                           <span>群众</span>
                       </td>
                       <td>
                           <span>职业：</span>
                           <span>ADC射手</span>
                       </td>
                       <td>
                           <span>手机号：</span>
                           <span>18888888889</span>
                       </td>
                   </tr>
                   <tr>
                       <td>
                           <span>社保卡号：</span>
                           <span>6224785698542556855</span>
                       </td>
                       <td>
                           <span>身份证号：</span>
                           <span>135524455986524441</span>
                       </td>
                   </tr>
                   <tr>
                       <td>
                           <span>户口地址：</span>
                           <span>北京市石景山区生命科学园</span>
                       </td>
                       <td>
                           <span>家庭住址：</span>
                           <span>北京市石景山区生命科学园D区1号楼2445</span>
                       </td>
                   </tr>
                   <tr>
                       
                       
                   </tr>
                   <tr>
                       <td>
                           <span>入住人病史介绍：</span>
                           <span>饮用矿泉水啥啥啥</span>
                       </td>
                       <td>
                           <span>入住人服药情况：</span>
                           <span>爱上大会的卡号贷款哈师大考好点</span>
                       </td>
                   </tr>
           </tbody>
        </table>
        <div class="pageBreak"></div>
        <br />
        <div class="header clear"></div>
        <!--步骤一的结束标志-->
        
        <h3 style="text-align: center;">家属信息登记</h3>
        <table class="tableTopBorder_3">
            <thead>
                <tr>
                    <th>姓名</th>
                    <th>性别</th>
                    <th>联系电话</th>
                    <th>联系地址</th>
                    <th>工作单位</th>
                    <th>与老人关系</th>
                    <th>是否监护人</th>
                </tr>
            </thead>
            <tbody>
                <tr>
                    <td>张三</td>
                    <td>男</td>
                    <td>18888888888</td>
                    <td>北京市石景山苹果园小区</td>
                    <td>太极大厦2楼</td>
                    <td>父子</td>
                    <td>是</td>
                </tr>
                <tr>
                    <td>李四</td>
                    <td>女</td>
                    <td>166666666665</td>
                    <td>北京市石景山苹果园小区</td>
                    <td>太极大厦2楼</td>
                    <td>父子</td>
                    <td>是</td>
                </tr>
            </tbody>
        </table>
        <div class="pageBreak"></div>
        <br />
        <div class="header clear"></div>
        <!--步骤二的结束标志-->
        
        
        <h3 style="text-align: center;">健康信息登记</h3>
        <table class="tableTopBorder_3">
            <tbody>
                <tr>
                    <td>
                        <span>身高：</span>
                        <span>18cm</span>
                    </td>
                    <td>
                        <span>体重：</span>
                        <span>18公斤</span>
                    </td>
                    <td>
                        <span>体温：</span>
                        <span>18°C</span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <span>体检报告编号：</span>
                        <span>111111111111111</span>
                    </td>
                    <td>
                        <span>老人区域分类：</span>
                        <span>自理区</span>
                    </td>
                    <td>
                        <span>接收否：</span>
                        <span>接收</span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <span>呼吸：</span>
                        <span>1000次/分</span>
                    </td>
                    <td>
                        <span>脉搏：</span>
                        <span>500次/分</span>
                    </td>
                    <td>
                        <span>血压：</span>
                        <span>2000毫米汞柱</span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <span>营养状况：</span>
                        <span>中等</span>
                    </td>
                    <td>
                        <span>其他：</span>
                        <span>胃病难受</span>
                    </td>
                    <td></td>
                </tr>
                <tr>
                    <td>
                        <span>睡眠情况：</span>
                        <span>自认入睡</span>
                    </td>
                    <td>
                        <span>药物名称：</span>
                        <span>阿莫西林</span>
                    </td>
                    <td>
                        <span>排便情况：</span>
                        <span>正常</span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <span>饮食情况：</span>
                        <span>流食</span>
                    </td>
                    <td>
                        <span>食欲：</span>
                        <span>好</span>
                    </td>
                    <td>
                        <span>管络情况：</span>
                        <span>人工通气</span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <span>目前治疗情况：</span>
                        <span>有</span>
                    </td>
                    <td>
                        <span>入院方式：</span>
                        <span>平车</span>
                    </td>
                    <td>
                        <span>既往史：</span>
                        <span>高血压、脑出血、糖尿病、高血压、脑出血、糖尿病</span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <span>过敏史：</span>
                        <span>不详</span>
                    </td>
                    <td>
                        <span>食物名称：</span>
                        <span>鱼香肉丝盖饭</span>
                    </td>
                    <td>
                        <span>药品：</span>
                        <span>感冒胶囊</span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <span>家属提供辅助检查资料：</span>
                        <span>有</span>
                    </td>
                    <td>
                        <span>长者健康类型：</span>
                        <span>半失能</span>
                    </td>
                    <td>
                        <span>行走：</span>
                        <span>步态不稳</span>
                    </td>
                </tr>
                
                <tr>
                    <td>
                        <span>排泄能力：</span>
                        <span>丧失功能</span>
                    </td>
                    <td>
                        <span>用餐：</span>
                        <span>部分帮助</span>
                    </td>
                    <td>
                        <span>洗澡：</span>
                        <span>部分帮助</span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <span>穿脱衣：</span>
                        <span>自理</span>
                    </td>
                    <td>
                        <span>上下床：</span>
                        <span>完全帮助</span>
                    </td>
                    <td>
                        <span>如厕：</span>
                        <span>部分帮助</span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <span>思维能力：</span>
                        <span>正常</span>
                    </td>
                    <td>
                        <span>语言表达能力：</span>
                        <span>轻度障碍</span>
                    </td>
                    <td>
                        <span>上下肢活动能力：</span>
                        <span>中度障碍</span>
                    </td>
                </tr>
            </tbody>
        </table>
        <div class="pageBreak"></div>
        <br />
        <div class="header clear"></div>
        <!--步骤三的结束标志-->
        
        
        <h3 style="text-align: center;">护理任务设置</h3>
        <table class="tableTopBorder_3">
            <tbody>
                <tr>
                    <td>
                        <span>护理级别：</span>
                        <span>高级</span>
                    </td>
                    <td>
                        <span>级别说明：</span>
                        <span>xxxxxx</span>
                    </td>
                    <td>
                        <span>级别费用：</span>
                        <span>5000元/月</span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <span>私人定制费用：</span>
                        <span>5000元/月</span>
                    </td>
                    <td>
                        <span>护理总费用：</span>
                        <span>8000元/月</span>
                    </td>
                    <td></td>
                </tr>
            </tbody>
        </table>
        <div class="pageBreak"></div>
        <br />
        <div class="header clear"></div>
        <!--步骤四的结束标志-->
        
        
        <h3 style="text-align: center;">餐饮床位选择</h3>
        <table class="tableTopBorder_3">
            <tbody>
                <tr>
                    <td>
                        <span>床号：</span>
                        <span>浩顺一号楼2015床</span>
                    </td>
                    <td>
                        <span>套餐费用：</span>
                        <span>5000元/月</span>
                    </td>
                    <td>
                        <span>套餐详情：</span>
                        <span>这是一个鱼香肉丝盖饭</span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <span>是否包房：</span>
                        <span>是</span>
                    </td>
                    <td>
                        <span>费用：</span>
                        <span>8000元/月</span>
                    </td>
                    <td>
                        <span>备注(信息)：</span>
                        <span>这是给1号床的病人食用的</span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <span>床位：</span>
                        <span>A床位</span>
                    </td>
                    <td>
                        <span>床位描述：</span>
                        <span>这是给一位警察的床位</span>
                    </td>
                    <td>
                        <span>床位类型：</span>
                        <span>一级床位</span>
                    </td>
                </tr>
                
            </tbody>
        </table>
        <div class="pageBreak"></div>
        <br />
        <div class="header clear"></div>
        <!--步骤五的结束标志-->
        
        
        <h3 style="text-align: center;">物品领用</h3>
        <table class="tableTopBorder_3">
            <thead>
                <tr>
                    <th>物品名称</th>
                    <th>单位</th>
                    <th>数量(个)</th>
                    <th>单价(元)</th>
                    <th>金额(总)</th>
                    <th>备注</th>
                </tr>
            </thead>
            <tbody>
                <tr>
                    <td>
                        <span>纸篓</span>
                    </td>
                    <td>
                        <span>A单位</span>
                    </td>
                    <td>
                        <span>50</span>
                    </td>
                    <td>
                        <span>50</span>
                    </td>
                    <td>
                        <span>50</span>
                    </td>
                    <td>
                        <span>住户好吃懒惰</span>
                    </td>
                </tr>
            </tbody>
        </table>
        <div class="pageBreak"></div>
        <br />
        <div class="header clear"></div>
        <!--步骤六的结束标志-->
        
        
        <h3 style="text-align: center;">入院缴费</h3>
        <table class="tableTopBorder_3">
            <thead>
                <tr>
                    <th>入住月收费用类别</th>
                    <th>收费标准(元)</th>
                    <th>本月应收(元)</th>
                    <th>备注</th>
                </tr>
            </thead>
            <tbody>
                <tr>
                    <td>
                        <span>床位费：</span>
                    </td>
                    <td>
                        <span>100</span>
                    </td>
                    <td>
                        <span>2000</span>
                    </td>
                    <td></td>
                </tr>
                <tr>
                    <td>
                        <span>护理费：</span>
                    </td>
                    <td>
                        <span>200</span>
                    </td>
                    <td>
                        <span>3000</span>
                    </td>
                    <td></td>
                </tr>
                <tr>
                    <td>
                        <span>订制护理费：</span>
                    </td>
                    <td>
                        <span>300</span>
                    </td>
                    <td>
                        <span>4000</span>
                    </td>
                    <td></td>
                </tr>
                <tr>
                    <td>
                        <span>物品领用表：</span>
                    </td>
                    <td>
                        <span></span>
                    </td>
                    <td>
                        <span>5000</span>
                    </td>
                    <td></td>
                </tr>
                <tr>
                    <td>
                        <span>餐饮费</span>
                    </td>
                    <td>0</td>
                    <td>
                        <span>应收月入住费</span>
                        <span>5000</span>
                    </td>
                    <td></td>
                </tr>
            </tbody>
        </table>
        
        <div class="resultTotalGuding">
            <h3 style="text-align: center;">固定</h3>
            <table class="tableTopBorder_3">
                <tbody>
                    <tr>
                        <td>
                            <span>夜壶：</span>
                            <span>5000</span>个
                        </td>
                        <td>
                            <span>烟袋锅：</span>
                            <span>2000</span>个
                        </td>
                        <td>
                            <span>水壶：</span>
                            <span>1000</span>个
                        </td>
                    </tr>
                </tbody>
            </table>
        </div>
        
        <div class="resultTotalKexuan">
            <h3 style="text-align: center;">可选</h3>
            <table class="tableTopBorder_3">
                <tbody>
                    <tr>
                        <td>
                            <span>早餐套餐：</span>
                            <span>5000</span>元
                        </td>
                        <td>
                            <span>中餐套餐：</span>
                            <span>2000</span>元
                        </td>
                        <td>
                            <span>晚餐套餐：</span>
                            <span>1000</span>元
                        </td>
                    </tr>
                </tbody>
            </table>
        </div>
        
        <div class="resultTotalMoney">
            <h3 style="text-align: center;">合计费用</h3>
            <table class="tableTopBorder_3">
                <tbody>
                    <tr>
                        <td>
                            <span>入住押金：</span>
                            <span>5000</span>元
                        </td>
                        <td>
                            <span>备用金：</span>
                            <span>2000</span>元
                        </td>
                        <td>
                            <span>实交费用：</span>
                            <span>1000</span>元
                        </td>
                    </tr>
                    <tr>
                        <td>
                            <span>付款方式</span>
                            <span>微信支付</span>
                        </td>
                        <td></td>
                        <td></td>
                    </tr>
                </tbody>
            </table>
        </div>
    </div>
 
<!--_footer 作为公共模版分离出去-->
<script type="text/javascript" src="lib/jquery/1.9.1/jquery.min.js"></script> 
<script type="text/javascript" src="lib/layer/2.4/layer.js"></script>
<script type="text/javascript" src="static/h-ui/js/H-ui.min.js"></script> 
<script type="text/javascript" src="static/h-ui.admin/js/H-ui.admin.js"></script> <!--/_footer 作为公共模版分离出去-->
 
<!--请在下方写此页面业务相关的脚本--> 
<script type="text/javascript" src="lib/My97DatePicker/4.8/WdatePicker.js"></script>
<script type="text/javascript" src="lib/jquery.validation/1.14.0/jquery.validate.js"></script> 
<script type="text/javascript" src="lib/jquery.validation/1.14.0/validate-methods.js"></script> 
<script type="text/javascript" src="lib/jquery.validation/1.14.0/messages_zh.js"></script>
<script type="text/javascript">
$(function(){
    window.print();
});
</script> 
<!--/请在上方写此页面业务相关的脚本-->
</body>
</html>